(excerpts from a HRW Report - http://www.hrw.org/reports/2003/usa1003/index.htm)
Ill-Equipped:
U.S. Prisons and Offenders with Mental Illness
Fifty years ago, public mental health care was based almost exclusively on institutional care and over half a million mentally ill Americans lived in public mental health hospitals. Beginning in the early 1960s, states began to downsize and close their public mental health hospitals, a process called �deinstitutionalization.� Many factors precipitated the process. The first generation of effective anti-psychotic medications and litigation led to dramatic changes in mental disability law that increased due process safeguards in mental hospital involuntary commitment and release procedures. Today, fewer than eighty thousand people live in mental health hospitals and that number is likely to fall still further. In 1955, the rate of persons in mental hospitals was 339 per one hundred thousand; by 1998, it had declined to twenty-nine per one hundred thousand.
Deinstitutionalization freed hundreds of thousands of mentally ill men and women from large, grim facilities to which most had been involuntarily committed and in which they spent years, if not decades or entire lives, receiving greatly ineffectual, and often brutal, treatment. Proponents of deinstitutionalization envisioned former mental health hospital patients receiving treatment through community mental health programs and living as independently in the community as their mental conditions permitted. This process was catalyzed by passage of the federal legislation providing seed funding for the establishment of comprehensive mental health centers in the community. Unfortunately, community mental health services have not been able to play the role the architects of deinstitutionalization envisioned. The federal government did not provide ongoing funding for community services and while states cut their budgets for mental hospitals, they did not make commensurate increases in their budgets for community-based mental health services. Chronically underfunded, the existing mental health system today does not reach and provide mental health treatment to anywhere near the number of people who need it.
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Deinstitutionalization resulted in the release of hundreds of thousands of mentally ill offenders to communities who could not care for them. At about the same time, national attitudes toward those who committed street crime � who are overwhelmingly the country�s poorest � changed markedly. Both the federal and state governments adopted a series of punitive criminal justice policies that encouraged increased arrests; increased the likelihood that conviction for a crime would result in incarceration, including through mandatory minimum sentencing and �three strikes� laws; increased the length of time served, by increasing the length of sentences and reducing or eliminating the availability of early release and parole; and increased the rate at which parolees are returned to prison. The U.S. rate of incarceration soared, becoming the highest in the world: 701 prisoners per one hundred thousand U.S. residents, or one in every 143 residents. Championed as protecting the public from serious and violent offenders, the new criminal justice policies in fact yielded high rates of confinement for nonviolent offenders.
Nationwide, nonviolent offenders account for 72 percent of all new state prison admissions. Almost one-third of new admissions are nonviolent drug offenders.
Most of those swept into the criminal justice system are poor, many are homeless, many have substance abuse problems, and many would be good candidates for alternatives to incarceration. Many of them are also mentally ill. In making America�s response to crime and drug use more punitive throughout the 1980s and 1990s, state and federal lawmakers inadvertently contributed to the imprisonment of greater numbers of mentally ill citizens. The percentage of America�s mentally ill population either living in prison, or having recently come out of prison, increased dramatically.